Abstract
Background: Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. However the situation for newer antidepressants and atypical antipsychotic medicines (AAPs) is different to PPIs, statins, and renin-angiotensin inhibitor drugs with greater tailoring of therapy and no wish to switch products in stable patients. Authorities welcome generics though given the high costs particularly of single-sourced AAPs. Objective: Assess (a) changes in utilization of venlafaxine versus other newer antidepressants before and after availability of generics, (b) utilization of generic versus originator venlafaxine, (c) price reductions of venlafaxine over time and their influence on total expenditure, (d) utilization of risperidone versus other AAPs, (e) suggest potential additional reforms that could be introduced if pertinent to further enhance the use of generics. Methodology: A quasi-experimental study design with a segmented time series and an observational study. Utilization measured in defined daily doses (DDDs) and total expenditure per DDD and over time. Results: No appreciable changes in the utilization of venlafaxine and risperidone after generics. The reduction in expenditure/DDD for venlafaxine decreased overall expenditure on newer antidepressants by 5% by the end of the study versus just before generics despite a 37% increase in utilization. Expenditure will further decrease if reduced prescribing of duloxetine. Conclusion: Depression, schizophrenia, and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic risperidone and venlafaxine when multiple choices are appropriate. Authorities cannot rely on a “Hawthorne” effect between classes to enhance the use of generics. Measures may include prescribing restrictions for duloxetine. No specific measures planned for AAPs with more multiple-sourced AAPs becoming available.
Highlights
Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms
The utilization of newer antidepressants increased by 37% from the launch of generic venlafaxine (IR and extended release (ER)) until the end of the study based on accumulated six monthly defined daily doses (DDDs) (Table 1)
This growth included increasing utilization of venlafaxine (Figure 1), there was no change in the overall utilization pattern of venlafaxine before and after the availability of generic immediate release (IR) and ER venlafaxine (Figure 1) with a probability of 0.591
Summary
Scrutiny over pharmaceutical expenditure is increasing leading to multiple reforms. This includes Austria with measures to lower generic prices and enhance their utilization. GENERAL Scrutiny on pharmaceutical expenditure has intensified across Europe with its growth outstripping other components of ambulatory care, resulting in pharmaceutical expenditure becoming the largest or equaling the largest cost component in ambulatory care (Wettermark et al, 2008; Godman et al, 2008a, 2009a, 2010a, 2012a; Coma et al, 2009; Sermet et al, 2010; Voncina et al, 2011) This growth is set to continue unless addressed, driven by well known factors including changing demographics, rising patient expectations, strict clinical targets, and the continued launch of new premium priced medicines (Garattini et al, 2008; Wettermark et al, 2008; Godman et al, 2008a, 2009a, 2010a, 2012a; Coma et al, 2009; Sermet et al, 2010; Voncina et al, 2011). These include physician IT systems highlighting the cheapest multiple-sourced product, which build on quarterly information sent to physicians, physicians’ prescribing costs benchmarked against each other coupled with financial incentives to prescribe the cheapest multiple-sourced product, as well as quality circles among physicians with the objective to increase the prescribing of generics versus originators (Godman et al, 2008a, 2009c, 2010a,c, 2012a; Spiegel et al, 2012)
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